Medication Abortion via Digital Health in the United States: A Systematic Scoping Review

Digital health, including telemedicine, has increased access to abortion care. The U.S. Food and Drug Administration (FDA) states that digital health is comprised of categories that include health information management (HIM) technology, mobile health (mHealth), personalized medicine, telehealth and telemedicine, and the use of wearable medical devices. Telehealth and telemedicine allow the delivery of healthcare services such as counseling, assessment, and clinical guidance from a distance through electronic means of communication. In recent years, the availability of intelligent digital health solutions has transformed the population and personalized healthcare.

Methodology and Review Scope

This scoping review systematically mapped studies conducted on abortion services via telemedicine, including their effectiveness and acceptability for abortion users and providers. All published papers included abortion services via telemedicine in the United States were considered. Articles were searched in PubMed, CINAHL, and Google Scholar databases in September 2022. The findings were synthesized narratively, and the PRISMA-ScR guidelines were used to report this study. Out of 757 retrieved articles, 33 articles were selected based on the inclusion criteria. These studies were published between 2011 and 2022, with 24 published in the last 3 years.

Effectiveness and Accessibility

Regarding medication abortion services provided outside of inpatient healthcare settings before 12 weeks of gestational age, telemedicine and telehealth technologies present an alternative to in-clinic abortion services. Previous studies have reported that the effectiveness of abortion services through telemedicine is comparable to that of in-person provision of abortion services. Specifically, the study found that the effectiveness of abortion services via telemedicine was comparable to in-clinic visits, with 6% or fewer abortions requiring surgical intervention. Telemedicine increased access to abortion care in the United States, especially for people in remote areas or those worried about stigma from in-person visits.

Acceptability and User Preferences

The convenience, flexibility of appointment times, and ensured privacy to abortion users may make abortion services via telemedicine preferable. Both care providers and abortion seekers expressed positive perceptions of telemedicine-based abortion services. However, abortion users reported mixed emotions, with some preferring in-person visits. The demand for medication and abortion services via telemedicine increased in the United States, particularly following the COVID-19 pandemic. Telemedicine offered a preferable option for abortion seekers and providers, though the feasibility of accessing abortion services via telemedicine in low-resource settings needs further investigation.

Key Reasons for Selecting Telemedicine Services

Based on the review findings, the following factors were the most common reasons for choosing telemedicine: